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　　This position will report to the Claims Manager, playing a unique and important role in our mission to change healthcare for the better. Experience in the healthcare industry and critical thinking skills will help the organization build an effective and efficient claims team. The claims team will review and oversee the adjudication of claims ranging from the simple data entry to complex specialty claim research. The Claims Team will analyze and process insurance claims, checking for validity. Ability to determine whether to return, deny, or pay claims while following organizational policies and procedures is a must. This job screens, reviews, evaluate online entry, error correction, and quality control for final adjudication of paper/electronic claims.

　　MINIMUM QUALIFICATIONS:EDUCATION, CERTIFICATION, AND/OR LICENSURE:1. High School diploma/GEDEXPERIENCE:One (1) year of experience working with medical or institutional claim data entry.OROne (1) year of customer service experience.

　　PREFERRED QUALIFICATIONS:EDUCATION, CERTIFICATION, AND/OR LICENSURE:1. Associate Degree in related healthcare field.EXPERIENCE:1. Two plus years of medical or institutional claims processing and customer service experience.

　　CORE DUTIES AND RESPONSIBILITIES:The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

　　Determines accuracy and completions of claim information. Entry/verifies claims data.Resolves claim edits, review history records, and determine benefit eligibility for service.Reviews payment levels to arrive at final payment determination.Meets all production and quality standards, maintaining workques according to department standards.Effectively communicates with internal and external staff.Elevates issues to next level of supervision, as appropriate.Ensures accuracy of data entered and record maintenance.Attends all required training classes, demonstrating proficiency and ability to learn.Other duties as deemed appropriate by the Claims Manager.PHYSICAL REQUIREMENTS:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

　　Ability to sit for extended periods of time.WORKING ENVIRONMENT:The work environment characteristics described here are representative of those an... For full info follow application link.

　　Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

　　The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)